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Is childhood obesity a form of neglect? – Cleveland thinks so

In the first case of its kind, on December 14th, 2011, a Cuyahoga County court in Cleveland, Ohio ruled to remove a 200-pound, 8-year-old boy from his mother’s custody. The ruling determined the boy’s obese health status was a form of childhood neglect, stating that the child’s mother was not doing enough to control his weight gain. County workers were first alerted about the boy’s health problems in early 2010 when his mother brought him into the hospital for breathing difficulties. At that time, the boy was diagnosed with sleep apnea, a direct health consequence related to his obesity. The boy was given a breathing machine to alleviate his acute symptoms. To maintain his long-term health, the social workers began to exercise their right to “protective supervision,” and began to monitor his weight fluctuations and subsequent health risks.

Upon recommendations by the social workers, the mother enrolled the boy in a special Rainbow Babies & Children’s Hospital Program called “Healthy Kids, Healthy Weight.” Since 2005, the program has evaluated 900 overweight and obese children between the ages of 4-8. A team of specialists, including physicians, nutritionists and psychologists, educate the children and their families about healthy eating habits. One of the program’s co-directors noted that the program is important for preventing the long-term consequences of weight gain. Typically, these children suffer from an increased likelihood of Type 2 diabetes, high cholesterol and hypertension, which can lead to a decreased life span, diminished quality of life and increased health care costs.

While the boy was enrolled in this program, he continued to gain weight. After a year of monitoring, on October 19th, 2011 social workers removed the boy away from his mother’s custody and placed him in a foster home, to evaluate whether an environmental change would help the child lose weight. In fact, it did, as the boy’s weight dropped to 192 pounds during the period. With the prosecution using this fact to bolster their argument, the court ruled against the mother, giving custody of the boy to his uncle. The mother will have weekly visits and spend the holidays unsupervised with her 8-year-old son. However, for the time being, officials view the boy’s obesity as an imminent health threat as reason enough to put him in an alternative

While this boy’s case has been addressed for now, there are about 1,380 third-graders in Cuyahoga County alone who are also severely obese.[i] The state health department predicts approximately 12 percent of the third-graders state weight are obese. The dilemma of this Cuyahoga County case – is childhood obesity a form of neglect? – remains unresolved for many other children. The case plays into an emerging national debate on the issue. While experts’ opinions vary, ranging from the need for aggressive intervention by removing the child from the home to passive intervention in the form of physician’s interventions, ultimately a contradiction exists. On one hand, the Cuyahoga County court has implicated a mother for child neglect because of her son’s weight; on the other hand, the food industry is permitted to, without regulation, target the same age population with their unhealthy food marketing campaigns.

Experts’ opinions on the matter vary. On one hand, researcher Dr. David Luwig, Harvard University professor and pediatric obesity expert, urges children’s service agencies to intervene in severe cases, sighting a failure to control imminent weight-related health concerns as a form of neglect.[ii] Experts urge that this neglect is similar to physical abuse – an imminent danger to the child’s health. Others, including Dr. Arthur Caplan, professor of bioethics at the University of Pennsylvania, advocates for a broader public –policy approach before separating families. While he agrees that “A 218-pound, 8-year-old is a time bomb,” Dr. Caplan underscores the impracticalities of such an approach. Approximately one third of America’s children are overweight or obese. Logistically speaking, the foster care system in the United States is not capable of taking care of all of them. Furthermore, the emotional and economic consequences of placing them in foster homes, followed by associated health care costs, does not make this a viable option. Instead, Professor Caplan urges that we reconsider the hypocritical policies of our nation, mainly the inevitable contradiction that exists when we categorize childhood obesity as neglect, yet allow for unrestricted food marketing to our children and instead develop a comprehensive public policy approach.

What are the ethical implications of removing a child from his home for weight concerns, while allowing for unregulated marketing of unhealthy foods (such as the recent controversy of advocating pizza to be considered a vegetable)? The Cuyahoga County boy may be one example; the national obesity crisis remains unresolved. Should this single case set the precedent for millions of other American children or will we demonstrate the political will and commit the resources to address obesity and reverse its toll for the next generation? Categorizing childhood obesity as neglect is, at best, a short-term solution. With the projected increasing obesity rates, it is infeasible and undesirable to remove all overweight or obese children from their parents’ custody. Furthermore, we must think about the emotional and mental implications as well as the stigma associated with disrupting a nuclear family unit. This is not a viable policy approach for the growing obesity epidemic among our nation’s youth. Further effective public policy approaches are needed that can be sustained long-term. Should the food industry be regulated in their campaigns targeting children? Should economic incentives exist for families who maintain a healthy start for their children? Whether or not these particular policies are adopted, the need for this national dialogue is urgent.

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